Provider Demographics
NPI:1093969693
Name:POLK, JULIE
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:POLK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SURF AVE
Mailing Address - Street 2:#9-L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3550
Mailing Address - Country:US
Mailing Address - Phone:917-589-0476
Mailing Address - Fax:
Practice Address - Street 1:501 SURF AVE
Practice Address - Street 2:#9-L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3550
Practice Address - Country:US
Practice Address - Phone:917-589-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist